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This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2011 Care Improvement Plus Silver Rx (Regional PPO SNP) in Pierce, Georgia

Medicare Advantage Plan Benefit Details in Plain Text
The following Medicare Advantage plan benefits apply to the Care Improvement Plus Silver Rx (Regional PPO SNP) (R9896 - 008) in Pierce, Georgia .

This plan is administered by .  To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the Care Improvement Plus Silver Rx (Regional PPO SNP) health and prescription benefit details in chart format or email and view benefits chart

Plan Premium
The Care Improvement Plus Silver Rx (Regional PPO SNP) has a monthly premium of $34.90. That is $418.80 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher. Please remember that the $34.90 montly premium is in addition to your Medicare Part B premium. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).

This Medicare Advantage Plan with Prescription Drug Coverage is a Regional PPO plan.

Prescription Drug Coverage: Deductible, Cost-sharing, Formulary
This plan does NOT have a deductible for the prescription drug coverage. That means that you have first dollar coverage. Some plans have a deductible that must be paid (in full) prior to the prescription coverage assisting in your prescription costs (see cost-sharing below). The maximum deductible for 2011 is $310. This plan (Care Improvement Plus Silver Rx (Regional PPO SNP)) has no deductible.

 
The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Since this plan has no deductible, your coverage (initial coverage phase) will start right away. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Care Improvement Plus Silver Rx (Regional PPO SNP)’s formulary is divided into 4 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows:
  • Tier 1 (Generic Drugs) contains 0 drugs and has a co-payment of $10.00.
  • Tier 2 (Preferred Brand Drugs) contains 0 drugs and has a co-payment of $45.00.
  • Tier 3 (Non-Preferred Brand Drugs) contains 0 drugs and has a co-payment of $95.00.
  • Tier 4 (Specialty Tier Drugs) contains 0 drugs and has a co-insurance of 33% of the drug cost.
    •   
Click here to browse the Care Improvement Plus Silver Rx (Regional PPO SNP) Formulary.

The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 7% of your generic drug prescription costs in the donut hole on your behalf.

The brand-name drug manufacturer will pay 50% and your plan will pay an additional 0% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 50% discount. The 50% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (Care Improvement Plus Silver Rx (Regional PPO SNP)) offers No Coverage during the Coverage Gap phase.

The Care Improvement Plus Silver Rx (Regional PPO SNP) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail.

** Cost **
Premium and Other Important Information
$34.9 monthly plan premium in addition to your monthly Medicare Part B premium.
This plan covers all Medicare-covered preventive services with zero cost sharing.
$6 700 out-of-pocket limit.
This limit includes only Medicare-covered services.
$6 700 out-of-pocket limit.
This limit includes only Medicare-covered services.
$6 700 out-of-pocket limit.
In-Network: This limit includes only Medicare-covered services.
Out-Of-Network: This limit includes only Medicare-covered services.
** Doctor and Hospital Choice **
Doctor and Hospital Choice
Referral required for network specialists (for certain benefits).
You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits.
** Extra Benefits **
Prescription Drugs
20% of the cost for Part B-covered chemotherapy drugs and other Part B-covered drugs.
20% of the cost for Part B drugs out-of-network.
This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at http://www.careimprovementplus.com/members/formulary--medicare-drug-plan-coverage.aspx on the web.
Different out-of-pocket costs may apply for people who
  • have limited incomes
  • live in long term care facilities or
  • have access to Indian/Tribal/Urban (Indian Health Service).
The plan offers national in-network prescription coverage (i.e. this would include 50 states and DC). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel).
Total yearly drug costs are the total drug costs paid by both you and the plan.
The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition.
Some drugs have quantity limits.
Your provider must get prior authorization from Care Improvement Plus Silver Rx (Regional PPO SNP) for certain drugs.
You must go to certain pharmacies for a very limited number of drugs due to special handling provider coordination or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website formulary printed materials as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov.
If the actual cost of a drug is less than the normal cost-sharing amount for that drug you will pay the actual cost not the higher cost-sharing amount.
If you request a formulary exception for a drug and Care Improvement Plus Silver Rx (Regional PPO SNP) approves the exception you will pay Tier 3: Non-Preferred Brand Drugs cost sharing for that drug.
$0 deductible.
You pay the following until total yearly drug costs reach $2 840:
Tier 1: Generic Drugs
Tier 2: Preferred Brand Drugs
Tier 3: Non-Preferred Brand Drugs
Tier 4: Specialty Tier Drugs
  • $10 copay for a one-month (30-day) supply of drugs in this tier
  • $45 copay for a one-month (30-day) supply of drugs in this tier
  • $95 copay for a one-month (30-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier
  • $30 copay for a three-month (90-day) supply of drugs in this tier
  • $135 copay for a three-month (90-day) supply of drugs in this tier
  • $285 copay for a three-month (90-day) supply of drugs in this tier
  • 33% coinsurance for a three-month (90-day) supply of drugs in this tier
    • Tier 1: Generic Drugs
    Tier 2: Preferred Brand Drugs
    Tier 3: Non-Preferred Brand Drugs
    Tier 4: Specialty Tier Drugs
  • $10 copay for a one-month (31-day) supply of drugs in this tier
  • $45 copay for a one-month (31-day) supply of drugs in this tier
  • $95 copay for a one-month (31-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (31-day) supply of drugs in this tier
    • Tier 1: Generic Drugs
    Tier 2: Preferred Brand Drugs
    Tier 3: Non-Preferred Brand Drugs
    Tier 4: Specialty Tier Drugs
  • $10 copay for a one-month (30-day) supply of drugs in this tier
  • $45 copay for a one-month (30-day) supply of drugs in this tier
  • $95 copay for a one-month (30-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier
  • $25 copay for a three-month (90-day) supply of drugs in this tier
  • $112.50 copay for a three-month (90-day) supply of drugs in this tier
  • $237.50 copay for a three-month (90-day) supply of drugs in this tier
  • 33% coinsurance for a three-month (90-day) supply of drugs in this tier
    • After your total yearly drug costs reach $2 840 you receive a discount on brand name drugs and pay 93% of the plan's costs for all generic drugs until your yearly out-of-pocket drug costs reach $4 550.
    After your yearly out-of-pocket drug costs reach $ 4 550 you pay the greater of:
    • A $ 2.50 copay for generic (including brand drugs treated as generic) and a $ 6.30 copay for all other drugs or
    • 5% coinsurance.
    Plan drugs may be covered in special circumstances for instance illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Care Improvement Plus Silver Rx (Regional PPO SNP).
    You will be reimbursed up to the full cost of the drug minus the following for drugs purchased out-of-network until total yearly drug costs reach $2 840:
    Tier 1: Generic Drugs
    Tier 2: Preferred Brand Drugs
    Tier 3: Non-Preferred Brand Drugs
    Tier 4: Specialty Tier Drugs
  • $10 copay for a one-month (30-day) supply of drugs in this tier
  • $45 copay for a one-month (30-day) supply of drugs in this tier
  • $95 copay for a one-month (30-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier
    • You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.
    You will be reimbursed up to 7% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 550.
    You will be reimbursed up to the discounted price for brand name drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 550.
    You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.
    After your yearly out-of-pocket drug costs reach $ 4 550 you will be reimbursed for drugs purchased out-of-network up to the full cost of the drug minus your cost share which is the greater of:
    • A $ 2.50 copay for generic (including brand drugs treated as generic) and a $ 6.30 copay for all other drugs or
    • 5% coinsurance.
    You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.
    Physical Exams
    $0 copay for routine exams.
    Limited to 1 exam(s) every year.
    $0 copay for the required Medicare-covered initial preventive physical exam and annual wellness visits.
    $0 copay for routine exams.
    Vision Services
  • 20% of the cost for one pair of eyeglasses or contact lenses after cataract surgery.
  • 0% to 20% of the cost for exams to diagnose and treat diseases and conditions of the eye.
  • 0% of the cost for up to 1 routine eye exam(s) every year
  • 0% of the cost for glasses
  • 0% of the cost for contacts.
    • $200 plan coverage limit for eye wear every year.
    $0 copay for eye exams.
    20% of the cost for eye exams.
    $0 copay for eye wear.
    20% of the cost for eye wear.
    Dental Services
    20% of the cost for Medicare-covered dental benefits.
    $15 copay for an office visit that includes:
  • up to 1 oral exam(s) every year
  • up to 1 cleaning(s) every year
  • up to 1 dental x-ray(s) every year
    • $15 copay for preventive dental benefits.
    20% of the cost for comprehensive dental benefits.
    Contact the plan for availability of additional in-network and out-of-network comprehensive dental benefits.
    ** Important Information **
    Premium and Other Important Information
    $34.9 monthly plan premium in addition to your monthly Medicare Part B premium.
    This plan covers all Medicare-covered preventive services with zero cost sharing.
    $6 700 out-of-pocket limit.
    This limit includes only Medicare-covered services.
    $6 700 out-of-pocket limit.
    This limit includes only Medicare-covered services.
    $6 700 out-of-pocket limit.
    In-Network: This limit includes only Medicare-covered services.
    Out-Of-Network: This limit includes only Medicare-covered services.
    Doctor and Hospital Choice
    Referral required for network specialists (for certain benefits).
    You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits.
    ** Inpatient Care **
    Inpatient Hospital Care (Acute)
    Plan covers 90 days each benefit period.
    You will not be charged additional cost sharing for professional services.
    Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    Inpatient Mental Health Care
    You get up to 190 days in a Psychiatric Hospital in a lifetime.
    Same deductible and copay as inpatient hospital care (see 'Inpatient Hospital Care')
    Except in an emergency your doctor must tell the plan that you are going to be admitted to the hospital.
    Same deductible and copay as inpatient hospital care (see 'Inpatient Hospital Care')
    Skilled Nursing Facility (SNF)
    Authorization rules may apply.
    Plan covers up to 100 days each benefit period
    No prior hospital stay is required.
    You will not be charged additional cost sharing for professional services.
    Home Health Care
    Authorization rules may apply.
    0% of the cost for each Medicare-covered home health visit.
    0% for home health visits.
    Hospice
    You must get care from a Medicare-certified hospice.
    ** Outpatient Care **
    Doctor Office Visits
    See 'Welcome to Medicare; and Annual Wellness Visit' for more information.
    20% of the cost for each primary care doctor visit for Medicare-covered benefits.
    20% of the cost for each in-area network urgent care Medicare-covered visit.
    20% of the cost for each specialist visit for Medicare-covered benefits.
    20% for each primary care doctor visit.
    20% for each specialist visit.
    Chiropractic Services
    20% of the cost for each Medicare-covered visit.
    Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers.
    20% of the cost for chiropractic benefits.
    Podiatry Services
    20% of the cost for each Medicare-covered visit.
    0% of the cost for up to 6 routine visit(s) every year
    Medicare-covered podiatry benefits are for medically-necessary foot care.
    0% of the cost for podiatry benefits.
    20% of the cost for podiatry benefits.
    Outpatient Mental Health Care
    Authorization rules may apply.
    45% of the cost for each Medicare-covered individual or group therapy visit.
    45% of the cost for Mental Health benefits.
    45% of the cost for Mental Health benefits with a psychiatrist.
    Outpatient Substance Abuse Care
    45% of the cost for Medicare-covered individual or group visits.
    45% of the cost for outpatient substance abuse benefits.
    Outpatient Hospital Services
    Authorization rules may apply.
    20% of the cost for each Medicare-covered ambulatory surgical center visit.
    20% of the cost for each Medicare-covered outpatient hospital facility visit.
    20% of the cost for ambulatory surgical center benefits.
    20% of the cost for outpatient hospital facility benefits.
    Emergency Care
    20% of the cost (up to $50) for Medicare-covered emergency room visits
    Worldwide coverage.
    If you are admitted to the hospital within 24-hour(s) for the same condition you pay $0 for the emergency room visit.
    Outpatient Rehabilitation Services
    Authorization rules may apply.
    There may be limits on physical therapy occupational therapy and speech and language pathology services. If so there may be exceptions to these limits.
    20% of the cost for Medicare-covered Occupational Therapy visits.
    20% of the cost for Medicare-covered Physical and/or Speech and Language Therapy visits.
    20% of the cost for Medicare-covered Cardiac Rehab services.
    20% of the cost for Occupational Therapy benefits.
    20% of the cost for Physical and/or Speech and Language Therapy visits.
    20% of the cost for Cardiac Rehab services.
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    Authorization rules may apply.
    20% of the cost for Medicare-covered items.
    20% of the cost for durable medical equipment.
    Prosthetic Devices
    Authorization rules may apply.
    20% of the cost for Medicare-covered items.
    20% of the cost for prosthetic devices.
    Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies
    $0 copay for Diabetes self-monitoring training.
    $0 copay for Nutrition Therapy for Diabetes.
    20% of the cost for Diabetes supplies.
    $0 copay for Diabetes self-monitoring training.
    $0 copay for Nutrition Therapy for Diabetes.
    20% of the cost for Diabetes supplies.
    ** Preventive Services **
    Bone Mass Measurement
    $0 copay for Medicare-covered bone mass measurement.
    $0 copay for Medicare-covered bone mass measurement.
    Colorectal Screening Exams
    $0 copay for Medicare-covered colorectal screenings.
    $0 copay for colorectal screenings.
    Immunizations
    $0 copay for Flu and Pneumonia vaccines.
    No referral needed for Flu and pneumonia vaccines.
    $0 copay for Hepatitis B vaccine.
    $0 copay for immunizations.
    Pap Smears and Pelvic Exams
    $0 copay for Medicare-covered pap smears and pelvic exams
    $0 copay for pap smears and pelvic exams.
    Prostate Cancer Screening Exams
    $0 copay for Medicare-covered prostate cancer screening.
    $0 copay for prostate cancer screening.
    ** Additional Benefits **
    Dialysis
    20% of the cost for renal dialysis
    $0 copay for Nutrition Therapy for End-Stage Renal Disease.
    20% of the cost for renal dialysis.
    $0 copay for Nutrition Therapy for End-Stage Renal Disease.
    Prescription Drugs
    20% of the cost for Part B-covered chemotherapy drugs and other Part B-covered drugs.
    20% of the cost for Part B drugs out-of-network.
    This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at http://www.careimprovementplus.com/members/formulary--medicare-drug-plan-coverage.aspx on the web.
    Different out-of-pocket costs may apply for people who
    • have limited incomes
    • live in long term care facilities or
    • have access to Indian/Tribal/Urban (Indian Health Service).
    The plan offers national in-network prescription coverage (i.e. this would include 50 states and DC). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel).
    Total yearly drug costs are the total drug costs paid by both you and the plan.
    The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition.
    Some drugs have quantity limits.
    Your provider must get prior authorization from Care Improvement Plus Silver Rx (Regional PPO SNP) for certain drugs.
    You must go to certain pharmacies for a very limited number of drugs due to special handling provider coordination or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website formulary printed materials as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov.
    If the actual cost of a drug is less than the normal cost-sharing amount for that drug you will pay the actual cost not the higher cost-sharing amount.
    If you request a formulary exception for a drug and Care Improvement Plus Silver Rx (Regional PPO SNP) approves the exception you will pay Tier 3: Non-Preferred Brand Drugs cost sharing for that drug.
    $0 deductible.
    You pay the following until total yearly drug costs reach $2 840:
    Tier 1: Generic Drugs
    Tier 2: Preferred Brand Drugs
    Tier 3: Non-Preferred Brand Drugs
    Tier 4: Specialty Tier Drugs
  • $10 copay for a one-month (30-day) supply of drugs in this tier
  • $45 copay for a one-month (30-day) supply of drugs in this tier
  • $95 copay for a one-month (30-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier
  • $30 copay for a three-month (90-day) supply of drugs in this tier
  • $135 copay for a three-month (90-day) supply of drugs in this tier
  • $285 copay for a three-month (90-day) supply of drugs in this tier
  • 33% coinsurance for a three-month (90-day) supply of drugs in this tier
    • Tier 1: Generic Drugs
    Tier 2: Preferred Brand Drugs
    Tier 3: Non-Preferred Brand Drugs
    Tier 4: Specialty Tier Drugs
  • $10 copay for a one-month (31-day) supply of drugs in this tier
  • $45 copay for a one-month (31-day) supply of drugs in this tier
  • $95 copay for a one-month (31-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (31-day) supply of drugs in this tier
    • Tier 1: Generic Drugs
    Tier 2: Preferred Brand Drugs
    Tier 3: Non-Preferred Brand Drugs
    Tier 4: Specialty Tier Drugs
  • $10 copay for a one-month (30-day) supply of drugs in this tier
  • $45 copay for a one-month (30-day) supply of drugs in this tier
  • $95 copay for a one-month (30-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier
  • $25 copay for a three-month (90-day) supply of drugs in this tier
  • $112.50 copay for a three-month (90-day) supply of drugs in this tier
  • $237.50 copay for a three-month (90-day) supply of drugs in this tier
  • 33% coinsurance for a three-month (90-day) supply of drugs in this tier
    • After your total yearly drug costs reach $2 840 you receive a discount on brand name drugs and pay 93% of the plan's costs for all generic drugs until your yearly out-of-pocket drug costs reach $4 550.
    After your yearly out-of-pocket drug costs reach $ 4 550 you pay the greater of:
    • A $ 2.50 copay for generic (including brand drugs treated as generic) and a $ 6.30 copay for all other drugs or
    • 5% coinsurance.
    Plan drugs may be covered in special circumstances for instance illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Care Improvement Plus Silver Rx (Regional PPO SNP).
    You will be reimbursed up to the full cost of the drug minus the following for drugs purchased out-of-network until total yearly drug costs reach $2 840:
    Tier 1: Generic Drugs
    Tier 2: Preferred Brand Drugs
    Tier 3: Non-Preferred Brand Drugs
    Tier 4: Specialty Tier Drugs
  • $10 copay for a one-month (30-day) supply of drugs in this tier
  • $45 copay for a one-month (30-day) supply of drugs in this tier
  • $95 copay for a one-month (30-day) supply of drugs in this tier
  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier
    • You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.
    You will be reimbursed up to 7% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 550.
    You will be reimbursed up to the discounted price for brand name drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4 550.
    You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.
    After your yearly out-of-pocket drug costs reach $ 4 550 you will be reimbursed for drugs purchased out-of-network up to the full cost of the drug minus your cost share which is the greater of:
    • A $ 2.50 copay for generic (including brand drugs treated as generic) and a $ 6.30 copay for all other drugs or
    • 5% coinsurance.
    You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.
    Dental Services
    20% of the cost for Medicare-covered dental benefits.
    $15 copay for an office visit that includes:
  • up to 1 oral exam(s) every year
  • up to 1 cleaning(s) every year
  • up to 1 dental x-ray(s) every year
    • $15 copay for preventive dental benefits.
    20% of the cost for comprehensive dental benefits.
    Contact the plan for availability of additional in-network and out-of-network comprehensive dental benefits.
    Hearing Services
    In general routine hearing exams and hearing aids not covered.
  • 20% of the cost for Medicare-covered diagnostic hearing exams
    • 20% of the cost for hearing exams.
    Vision Services
  • 20% of the cost for one pair of eyeglasses or contact lenses after cataract surgery.
  • 0% to 20% of the cost for exams to diagnose and treat diseases and conditions of the eye.
  • 0% of the cost for up to 1 routine eye exam(s) every year
  • 0% of the cost for glasses
  • 0% of the cost for contacts.
    • $200 plan coverage limit for eye wear every year.
    $0 copay for eye exams.
    20% of the cost for eye exams.
    $0 copay for eye wear.
    20% of the cost for eye wear.
    Physical Exams
    $0 copay for routine exams.
    Limited to 1 exam(s) every year.
    $0 copay for the required Medicare-covered initial preventive physical exam and annual wellness visits.
    $0 copay for routine exams.
    Health/Wellness Education
    Please visit our plan website to see our list of covered Over-the-Counter items. OTC items may be purchased only for the enrollee. Please contact the plan for specific instructions for using this benefit.
    The plan covers the following health/wellness education benefits:
  • Written health education materials including Newsletters
  • Nutritional Training
  • Additional Smoking Cessation
  • Nursing Hotline
  • Other Wellness Benefits
    • $0 copay for each Medicare-covered smoking cessation counseling session.
    $0 copay for each Medicare-covered HIV screening.
    HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy.
    $0 copay for Health and Wellness services.
    Transportation
    Authorization rules may apply.
    $0 copay for up to 24 one-way trip(s) to plan-approved location every year.
    $0 copay for transportation.
    Acupuncture
    This plan does not cover Acupuncture.




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    • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
    • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
    • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
    • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
    • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
    • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
    • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
    • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
    • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
    • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
    • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
    • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
    • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
    • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
    • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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